Gambaran karakteristik fraktur radius distal di RSUP Sanglah Tahun 2013-2017

Background: Radius distal fracture is the most common fracture seen in emergency department which involves the upper extremity. Radius distal fracture can occur in any age, ranging from children, teenager until elderly patients. There is an increasing trend of radius distal fracture. However, the research on radius distal fracture characteristic, especially in Bali, is still limited.

Method: This study was a descriptive-retrospective study which aims to find out the characteristic of radius distal fracture at Sanglah General Hospital, Denpasar, Bali. For data collection, we used total sampling technique using secondary data from patients’ medical records. The study sample was all patient diagnosed with radius distal fractures between the year 2013-2017 with incomplete medical record as the exclusion criteria.

Result: This study obtained 677 radius distal fracture samples. Most of the patients were male [434 cases (64,1%)] with the most common age range was between 20-29 years old [147 cases (21,7%)]. The most common etiology of radius distal fracture was traffic accident [322 cases (47,6%)]. Fracture of the other upper extremity parts, in addition to radius distal, was the most common complaints accompanying radius distal fractures [333 cases (49,2%]. Based on the length of stay, 84% patients were hospitalized less than 5 days.

Conclusion: Distal radial fracture was commonly seen in men with the age range between 20-29 years old. Traffic accident was the most common cause of distal radial fracture with the average length of stay less than 5 days.

Self-esteem formation among people who are in rehabilitation for drug abuse in Bangli Mental Health Hospital, Bali, Indonesia

Background: Self-esteem formation is an essential aspect for people who use drugs to support the success of a rehabilitation program, and to prevent ongoing relapse. However, self-esteem formation is not a priority in the rehabilitation program. It also tends to ignore the drug abuse status and psychological states of its clients. This study aimed to explore self-esteem formation among people who are in rehabilitation for drug abuse at the Bangli Mental Health Hospital. Findings from this study provide insights to the hospital on the importance of self-esteem formation through a rehabilitation program.

Metode: A qualitative study was conducted in the Bangli Mental Health Hospital. We recruited a total of ten informants purposively who are in a rehabilitation program for at least two weeks for drug abuse at the Darmawangsa Ward Bangli Mental Health Hospital. Data were collected through in-depth interviews. Data were analyzed inductively and were presented using a narrative approach.

Results: Our in-depth interviews found that self-esteem formation among people who are in rehabilitation for drug abuse depends on various factors such as family support, peer support, life experience, skills and traits, spirituality, policies, parenting history, physical and social environments.

Conclusion: Self-esteem formation is determined by various factors and the drug abuse status of informants. We hope that the Bangli Mental Health Hospital can provide rehabilitation services tailored for every drug abuse status during their recovery time at the rehabilitation center.

Hubungan kadar serum gamma-glutamyl transferase dengan profil lipid pada Diabetes Melitus-Tipe 2 (DM-2) terkontrol dan tidak terkontrol di Rumah Sakit Umum Pusat Haji, Adam Malik Medan, Indonesia

Background: Diabetes mellitus is a group of metabolic diseases with characteristics of hyperglycemia that occur due to impaired insulin secretion, insulin work, or both whereas also impaired lipid peroxidation caused by oxidative stress. Gamma-glutamyl transferase (GGT) is an enzyme on the surface of the cell membrane that is responsible for the catabolism of glutathione which acts as a marker of oxidative stress. This study aims to determine the relationship of serum GGT levels with lipid profiles in controlled and uncontrolled type 2 DM.

Method: A cross-sectional study was conducted at H. Adam Malik General Hospital Medan from September - November 2018 among 60 patients with type 2 DM grouped according to HbA1c <7% controlled and HbA1C > 7% uncontrolled. GGT levels and lipid profiles examined using enzymatic calorimetry and HbA1c with Immunoturbidimetry method. The relationship of serum GGT levels with lipid profiles in controlled DM-2 was tested using the Pearson correlation test whereas controlled DM-2 correlation test using the Spearman's correlation test using SPSS version 21 for Windows.

Results: Most of respondents were males with HbA1C levels <7% (53.3%) and HbA1C ≥ 7% (60.0%). There was no difference in the mean age and serum GGT levels between uncontrolled DM-2 or controlled DM-2 group (P = 0.260 and P = 0.520, respectively). There was no association between serum GGT levels and lipid profiles in the controlled type 2 DM group and uncontrolled type 2 DM. (r=P> 0.05).

Conclusion: There is no significant relationship between serum GGT levels and lipid profiles in controlled and uncontrolled type 2 DM groups.

Characteristic overview of aplastic anemia at Sanglah Hospital, Bali-Indonesia in 2017-2018

Methods: This research is a cross sectional descriptive study with sources of data were medical records of aplastic anemia patients at Sanglah Hospital in the last 2 years, 2017-2018. Distribution of research variables is gender, age, laboratory examination, and severity.

Results:The result showed that 11 data were 6 (55%) male and 5 female (45%), with the mean age was 48 ± 14 years. The highest incidence occurred in the age range of 26-60 years old with 7 patients (64%). In this study the average hemoglobin level obtained was 9.94 ± 1.46 g/dL with range between 6.65 to 12.49 g/dL. The average number of leukocytes was 11.91 ± 24.52 x 10⁹ L with range of leukocytes is 1.99-84.58 x 10⁹/L. The average number of absolute Neutrophils and percent was 1.53 ± 1.52 x 10⁹/L and 25.99 ± 25.79% with range between 0.06 – 4.53 x 10⁹/L and 2.3 - 70.83%. The average platelet count was 24.77 ± 11.35 x 10⁹/L with range between 4.25 – 42.58 x 10⁹/L. The highest cases were nonsevere aplastic anemia (NSAA) with 7 people (64%).

Conclusion: The value of laboratory parameters for complete blood examination (leukocytes, platelets, hemoglobin, and neutrophils) in patients with aplastic anemia at Sanglah General Hospital is still very low, so it is a challenge for clinicians to carry out treatment of aplastic anemia and management related complications.

Faktor-faktor yang mempengaruhi kejadian kurang energi kronis (KEK) pada ibu hamil di wilayah kerja UPT Puskesmas I Pekutatan, Jembrana, Bali

Background: Common nutritional problems in pregnant women are chronic energy deficiency (CED). CED in pregnant women is a state of the mother lack of energy and protein intake during the period of pregnancy which can lead to the occurrence of health problems in the mother. This study aims to determine factors assoIKated with CED among pregnant women at UPT Puskesmas I Pekutatan, Jembrana, Bali.

Methods: A case control study was conducted among 36 respondents, 12 cases (KEK) and 24 control (Non-KEK). The sampling technique used is purposive sampling technique. Affordable populations in this study were pregnant women recorded in medical records data at UPT Puskesmas I Pekutatan period 01 January-31 May 2017. The data were collected by interview using questionnaire and assessed using SPSS software version 20 for Windows. Existing data were analyzed by univariate and Fisher's exact bivariate with odds ratio calculation (OR).

Results: About 13 respondents (36,1%) are <20 years old /> 35 years old with the most recent education is graduated from SMA that is 20 respondents (55,6%). Most respondents did not work (91.7%) and had low economic status (30.6%). Most of the respondents had children <2 (69.4%). Economic status (OR = 115; 95% IK: 9,3-1418), education level (OR = 2,3; 95% IK: 0,5-9,5), age (OR = 7,6; 95% IK: 1.6-35.9), gestational distance (OR = 11; 95% IK: 1.7-69), number of parities (OR = 7.6; 95% IK: 0.7-83.7) , And visit frequency of ANC (OR = 5; 95% IK: 0,9-26,4).

Conclusion: The characteristic and frequency of ANC visit among pregnant women are risk factors of KEK occurrence in pregnant mother, so it is expected to provide information related to risk factors of KEK by health personnel in Puskesmas I Pekutatan, state of Jembrana.

Hubungan ASI eksklusif terhadap terjadinya diare akut di Puskesmas III Denpasar Utara periode 2018

Introduction: Diarrhea is still a public health problem in developing countries, including Indonesia, because of its high morbidity and mortality. Breast milk is one of the important factors to reduce mortality and morbidity due to diarrhea. The aim of this study was to determine the relationship of exclusive breastfeeding to the occurrence of acute diarrhea. This research is analytic research with cross sectional method.

Method: The study was carried out in Community Health Centre III Subdistrict of North Denpasar from October to November 2018. The research subjects were taken by consecutive sampling. Data analysis used the prevalence ratio calculation and chi square test to determine the relationship between exclusive breastfeeding and the incidence of diarrhea.

Result: In this study the results of acute diarrhea patients in the exclusive breastfeeding group were 17 children and non-exclusive breastfeeding as many as 31 children. Subjects who did not experience acute diarrhea in the excluded breastfeeding group were 28 children and in the non-exclusive breastfeeding group as many as 14 children. The results of statistical analysis showed the value of p=0.003 (p<0.05)  PR=0.514 CI 95% (0.115-0.656).

Conclusion: Exclusive breastfeeding has a significant relationship with the incidence of acute diarrhea and is a protective factor for the incidence of diarrhea.

Pengaruh obesitas pada kualitas tidur mahasiswa Fakultas Kedokteran Universitas Udayana periode 2018

Introduction: Increased obesity rates in adolescents can lead to the emergence of new risk populations for the occurrence of sleep disorders. The emergence of sleep disorders will have a direct impact on decreasing the quality of sleep. This study aims to determine the effect of obesity on the sleep quality of students of the Faculty of Medicine, Udayana University.

Method: The study design was cross sectional analytic with a total sample of 74 students of the Medical Faculty of Udayana University (37 samples of the Body Mass Index (BMI) obesity and 37 samples of the normal BMI). Sample selection is done randomly. Measuring sleep quality was done through filling in the Pittsburgh Sleep Quality Index (PSQI) questionnaire and measuring obesity was done by calculating BMI. The answers to the questionnaire were scoring and based on the global score, sleep quality was categorized into poor and good sleep quality. The PSQI questionnaire also included questions about health problems experienced by students in the past month. Data analysis is presented in the form of tables and narratives.

Result: The results showed that in the obese student group there were 22 samples with poor sleep quality (53.7%) and 15 samples with good sleep quality (45.5%). In the normal IMT student group there were 19 samples with poor sleep quality (46.3%) and 18 samples with good sleep quality (54.5%). In 20 students with health problems, there were 15 samples with poor sleep quality and 5 samples with good sleep quality. In 54 students without health problems, 26 samples with poor sleep quality and 28 samples with good sleep quality. Analysis using chi-square showed obesity did not have a significant effect on sleep quality (p = 0.483). There was a significant effect of health problems on sleep quality (p = 0.039).

Conclusion: Conclusions of the study were obesity did not have a significant effect on the quality of sleep of students of the Faculty of Medicine, Udayana University.

Gambaran aspek lingkungan dan perilaku pencegahan penularan tuberkulosis paru pada pasien tuberkulosis paru di wilayah kerja Puskesmas Dawan I, Kabupaten Klungkung tahun 2017

Pendahuluan: Tuberkulosis paru adalah penyakit reemerging dan masih ditemukan di Provinsi Bali. Untuk mengurangi bertambahnya TB paru dan masalah yang ditimbulkan, perlu dilakukan penanganan awal yang dapat dilakukan yaitu di lingkungan keluarga. Selain untuk menyembuhkan pasien dan mencegah kematian, tujuan pengobatan TB lainnya yaitu mencegah kekambuhan dan memutuskan rantai penularan.

Tujuan: Mengetahui gambaran aspek lingkungan dan perilaku pencegahan penularan tuberkulosis paru pada pasien TB Paru di wilayah kerja Puskesmas Dawan I

Metode: Penelitan ini menggunakan pendekatan deskriptif menggunakan rancangan cross-sectional pada populasi pasien TB paru di Puskesmas Dawan I, Klungkung. Sampel ditentukan melalui total sampling, yaitu pasien tuberkulosis dengan BTA (+) selama tahun 2016-2017. Instrumen yang digunakan berupa kuesioner tentang gambaran aspek lingkungan dan perilaku pencegahan penularan tuberkulosis paru. Data yang telah terkumpul dianalisa secara deskriptif dengan program SPSS.

Hasil: Gambaran responden yaitu 68,4% usia produktif; tamatan SMA 42,1%; PNS/pensiunan dan buruh 31,6%; keluarga kurang mampu 47,4%. Pada aspek lingkungan penderita TB, pencahayaan cukup 68,4%; kamar mandi cukup 89,5%; penghuni 1-3 orang 63,2%; luas ventilasi kamar tidur kurang 57,9%. Pada aspek pengetahuan mayoritas pengetahuan masyarakat tentang TB sudah baik.

Simpulan: Sebagian besar penderita TB paru berada pada rentang usia produktif, jenis kelamin perempuan, berpenghasilan rendah, tingkat pendidikan rata-rata SMA. Mayoritas responden memiliki tempat tinggal dan pencegahan penularan penyakit yang sudah baik.

Karakteristik klinikopatologi karsinoma kolorektal di RSUP Sanglah, Bali, Indonesia tahun 2013-2017

Background: Colorectal cancer is the third most common cancer in the world and the fourth leading cause of cancer death. The etiology of colorectal carcinoma is an unhealthy lifestyle and a poor diet such as excessive consumption of fat. This study aims to determine the characteristic of the clinicoopatological on colorectal carcinoma patients at Sanglah Hospital Denpasar 2013-2017.

Methods: A cross-sectional study was conducted with a purposive sampling technique, on all patients who met the inclusion criteria. The tools used in data collection are medical records and their complaints that are found in the Anatomy Department of Sanglah Hospital. Data recorded includes age, grade, stage, and histopathology. The data analysis method uses SPSS version 17 for Windows.

Results: A total of 121 cases were collected where most were in the age range of 50-60 years, as many as 48 cases (39.7%). In addition, Grade 2 was 98 cases (81.0%), followed by histopathological type with adenocarcinoma not otherwise specified as many as 118 cases (97.5%). Stadium 2 cases were 65 cases (53.7%), and 72 cases (59.5%) were males.

Conclusion: Most cases are in the range of 50-60 years of age which is followed by Grade 2, histopathological type of adenocarcinoma not otherwise specified, stage 2 and male sex

The characteristic of tinea capitis in children among dermato-venereology outpatients’ polyclinic at Sanglah General Hospital, Denpasar from 2014-2017: a preliminary study

Background: Tinea capitis is a type of dermatophytosis (skin disease) caused by the infection of dermatophytes. It is generally caused by the dermatophyte species of Microsporum and Trichophyton. It has been known to be able to spread human to human and animal to human. It is also almost commonly found in the prepubertal age and very rare among the adults of either gender. This study aims to determine the prevalence of Tinea capitis in children by age, sex, clinical manifestation, laboratory tests, and treatments.

Methods: A cross-sectional observational study from the medical records of patients with Tinea capitis was conducted at Dermato-Venereology Outpatient Clinic RSUP Sanglah from 2014 to 2017. A total of 5 research variables were identified for this study: age, sex, clinical manifestation, laboratory tests, and treatment. The data was then analyzed and interpreted and further presented in forms of description, tables and graphs in this study by using SPSS version 17 for Windows

Results: A total of 32 patients were identified as having Tinea capitis from the period of 2014–2017. There was a slightly higher prevalence in the male gender (56.25%) compared with female gender (43.75%). The highest prevalence of the disease was found in the age groups of 1 – 5 and 6 – 10 years old with 43.75% respectively. Majority of the patients showed the presence of grey patch on their scalp on examination (53.13%). The dermatophyte Trichophyton rubrum had the highest isolation in comparison with other dermatophytes at 25.00%. The patients were almost all treated with oral Griseofulvin.

Conclusion: The majority diagnosis of Tinea capitis was found in group 1-5 and 6-10 years old and had a grey patch appearance, whereas Trichophyton rubrum as the highest isolation in comparison with other dermatophytes

Hubungan kadar TNF-α dengan HOMA-IR pada pasien diabetes mellitus tipe-2 di Rumah Sakit Umum Pusat Haji Adam Malik, Medan, Indonesia

Background: The homeostatic assessment (HOMA) of the first cell-β (B) and insulin (IR) function is used to determine insulin sensitivity and cell-β function of insulin plasma concentrations and fasting glucose. High extracellular glucose levels will trigger an increase in ROS production (which in turn will increase the formation of Reactive Oxygen Species) expression of TNF α (Tumor Necrosis Factor-α) and exacerbate oxidative stress. The study aimed to determine the relationship between TNF α and HOMA-IR in type 2 DM.

Method: A cross sectional study was conducted at the H. Adam Malik General Hospital Medan from December-February 2018 in 43 patients with type 2 DM. Fasting insulin levels were examined using Celuminescence Microparticle Immunoassay and fasting glucose levels with Enzymatic and TNF α methods with the Elisa method. The relationship of the characteristics of TNF α levels with HOMA-IR in type 2 DM using the Kolmogorov Smirnov test used the Spearman's rank correlation test with SPSS version 20 for windows.

Results: The total sample was 43 samples of patients with type 2 diabetes mellitus. Most of the respondents were male (62.8%) and had a median age of 57 (39-87) years. In this study, the TNF-alpha levels were 87.28 (18.43-846.05) pg/ml. While the HOMA-IR level was 3.36 (0.41-25.82). There was no significant correlation between serum TNF α levels and HOMA-IR in type 2 DM patients (P> 0.05).

Conclusion: There is no significant relationship between TNF α levels and HOMA-IR in type 2 DM patients.

Correlation between extracurricular activities and academic performances among preclinical medical students in Udayana University, Bali, Indonesia

Background: Medical students are required to develop ability and clinical skill to carry out the profession. Soft skill is also important to enhance the students’ performance when facing real-life situation in community. It can be developed through extracurricular activity which trains positive behavior, time management, and social aspect. This study was aimed to explore the correlation between extracurricular activities and academic performances among medical students in preclinical phase.

Summary of Work: A cross-sectional study with total of 221 medical students of Udayana University in preclinical phase. Data were taken from data collecting by Student Executive Board for Credit Point of Participation which was the indicator of extracurricular activities and grouped into active and not active. Data were also taken from Academic Affair’s registered data (Grade Point Average (GPA) and gender). GPA was the indicator of academic performance and grouped into good and average. Data were analyzed using univariate and bivariate analysis (Chi Square Test with Cramer’s V).

Summary of Results: From 221 medical students (males 43.9%; females 56.1%), 48% are active participants of extracurricular programs. Fifty-nine medical students had good GPA and 162 medical students had average GPA. The mean score of Credit Point of Participation are 116.545±65.79 and GPA is 3.3781±0.282 (out of possible 4). Our study showed a positive correlation between extracurricular activities and academic performance (r=0.2; p=0.003).

Discussion & Conclusions: Medical students who are active participants in extracurricular programs have better academic performance than those who are passive. This finding may have similar result to some previous studies. Extracurricular activities lead to positive impact in academic achievement, because it can decrease any academic stress and tension, which lead into more productivity in their learning.

Berat badan lahir lebih dari 4000 gram merupakan faktor risiko kejadian mikropenis pada bayi baru lahir di Denpasar tahun 2019

Background: Standard values related to age for penis size can help for early diagnosis and treatment of potential diseases. Rapid changes in growth and interindividual differences can occur during infancy and puberty. Therefore, micropenis data during newborns are beneficial for clinical evaluation and prognosis.

Aim: This study aims to find out whether birth weight > 4000 grams and testis size <0.52 cm are risk factors for micropenis prevalence in newborns.

Methods: This study used a descriptive-analytical cohort study involving 85 research subjects, namely healthy newborn boys who did not experience hypospadias, severe chordae, ambiguous penises. Respondents contributed to physical examinations and investigations following the standard procedure in the analysis of the weight, gestational age, and size of the testis. The study also evaluated the risk factors for micropenis in the form of a history of maternal hormonal birth control.

Results: The micropenis was categorised to be <1.8 cm, which was obtained from <2.5 SD mean where the size of penis length in this study was achieved with a mean of 2.08 cm. The results of the multi-variate test showed that birth weight> 4000 grams was the most dominant risk factor causing micropenis. The positive B value with a value of 5.13, which means birth weight> 4000 grams has a positive relationship with the incidence of micropenis. The newborn weight was obtained about p = 0,000 (95%CI: 11,29-2558,17) with OR 170 which mean that there was an effect of birth weight on the incidence of micropenis where birth weight> 4000 grams had a chance of micropenis by 170 times.

Conclusion: Weight> 4000 grams became the most dominant risk factor for micropenis having probabilities for a micropenis approximately 170 times.

The suitability of sputum and blood culture in children with pneumonia at Sanglah General Hospital, Bali, Indonesia

Background: Pneumonia is one of the diseases in children with high morbidity, especially in children under 5 years old. In developing countries, the most common cause of pneumonia is bacteria. There is a newer method that gives a better reflection of the aetiology, which is the sputum examination. This study aims to determine the suitability of sputum and blood culture in children with pneumonia at Sanglah General Hospital, Bali.

Methods: A cross-sectional study was conducted at Respirology Subdivision in Department of Child Health Sanglah Hospital from November 2016 until February 2017. A categorical comparative matching was carried out between 2 formula groups. The sputum culture and blood culture were obtained through Microbiology Laboratory at Sanglah General Hospital. Data were analysed using SPSS version 16 for Windows.

Results: There were 50 children with pneumonia enrolled in this study. The children aged less than 1 years old were predominant (62%). There were a statistically systematic difference and only a fair agreement between blood and sputum culture (ĸ=0.257; p= 0.004). In a subject with positive sputum culture, 90.9% had a better outcome than the positive blood culture even though no statistically significant (RR=0.23; 95%CI: 0.15-22.53)

Conclusion: There is suitability between the culture of sputum and blood cultures in children with pneumonia. Sputum culture has a higher probability to reveal the microorganism compared to blood cultures.

Ascites permagna caused by large mesenteric cyst in 2 years old male: A case report

Background: Mesenteric cysts are documented as a rare entity in the pediatric population. They are considered as benign intraabdominal tumors with an unknown etiology and may occur anywhere in the mesentery of the gastrointestinal tract from the duodenum to the rectum. They are most commonly located in the mesentery of the ileum followed by localization in the sigmoid mesocolon. Approximately one-third of mesenteric cysts occur in children younger than 15 years of age and are slightly more common in males. The surgery is the common methods to remove the cyst.

Case presentation: A 2-year-old boy was hospitalized with a history of the bloated abdomen and dull achy pain on the left side of the abdomen since I year before admitted. Physical examination revealed distended of abdomen and ascites. Laboratory investigation showed normal limit; ultrasonography investigation showed cystic lesion and fluid collection in the cavum abdomen. It was confirmed with a CT scan. We diagnosed the patient with ascites permagna et causa suspected mesenteric cyst. After the diagnosis, a laparoscopic exploration and drainage ascites and total resection of the cyst were performed. Seven days after surgery, the patient was in good condition and discharged from the hospital — no distention in the abdomen.

Conclusion: The mesenteric cyst can be the cause of ascites and can be well treated with laparoscopic modalities; the outcome is excellent with no malignancy founded.

Management of denture foreign body in esophagus with cervical esophagotomy: case report

Introduction: Impaction of dentures in the esophagus is a distressing experience for a patient and can lead to serious consequences, such as esophageal perforation. Patients with an impacted denture often present with a history of accidental swallowing, frequently during trauma, seizures, or sleep or in association with some degree of psychological dysfunction. The common signs and symptoms of an impacted denture are odynophagia, dysphagia, or simply pain and tenderness in the neck or chest.The preferred method of removal of esophageal foreign bodies is extraction with the flexible endoscope. Surgical removal is rarely indicated except in the event of perforation or other foreign body complications.In situations where this appears potentially hazardous, such as with impacted denture, open surgical extraction by cervical oesophagotomy is promptly performed is a safe option.

Cases Report: The successful removal of impacted denture in the esophagus in a patient is reported, with a review of the literature. A women23-year-old  complained of dysphagia after swallowing his denture. Following unsuccessful attempts at removal via a rigid esophagoscope, open surgery was performed. Without further delay, the impacted denture was removed by cervical oesophagotomy, and the patient recovered uneventfully.

Conclusion: The successful removal of impacted denture by cervical oesophagotomy in the esophagus in a patient is reported. We conclude that cervical esophagotomy is a safe method for removing foreign bodies impacted in the cervical esophagus when they cannot be removed endoscopically.